The ketogenic diet for infants: How long can you go?

Purpose: Ketogenic diets (KD) are high-fat, low-carbohydrate therapies, established in the treatment for drug-resistant epilepsy in childhood since the 1920ies. This review focuses on the use of ketogenic diet therapies in young childhood with an emphasis on the most recent advances. Findings: The KD has been used effectively and safely in childhood, and has increasingly been offered in infancy during the last decade. The introduction of a KD is recommended with a fixed fat/non-fat ratio of 3:1, modified if necessary. In infants the KD is initiated without fasting and fluid restriction and with a shorter treatment duration than in older children. Twenty studies that also included infants below 1 year of age are available. When the KD is used early and in an approach based on syndromes and etiology, seizure freedom is achieved and maintained more often than when used as last ressort. In infants with genetic causes already recognized in early infancy, the KD has shown to be even more effective. Most frequent adverse effects in infancy include emesis, hypoglycemia, food/liquid refusal and constipation which are mostly transient and resolvable by dietary adjustments. Promising data on the inclusion of expressed breast milk to the KD and maintaining actual breastfeeding while on the KD have shown that complete weaning from breast-feeding is not necessary and inclusion of breast milk as well as breastfeeding should be encouraged. Summary: The ketogenic diet is a versatile therapy, and effective and safe in its use in infancy. There is growing evidence and guidelines that specify indications where the KD should be used early.